Complications
As Aspergillus is angio-invasive, the organism produces thromboses in pulmonary microvasculature and haemorrhage leading to haemoptysis. It can be severe and fatal, particularly in patients with underlying thrombocytopenia.
Presence of pleuritic pain and haemoptysis in a high-risk patient should raise the suspicion for invasive aspergillosis. In many cases, haemoptysis may gradually subside as infection is controlled; however, bleeding may become severe, requiring surgery.
Progressive pulmonary disease may lead to dissemination in patients with on-going severe immunosuppression.[130] Every organ system can be affected, with fatality approaching 90%. The organism is carried via the haematogenous route and has a predilection for the brain and skin.
In cerebral aspergillosis, the clinical and radiological features (brain abscess with ring enhancement and surrounding oedema) are non-specific. Mortality is high, although therapy with voriconazole has improved outcome.
In immunocompromised patients, Aspergillus rhinosinusitis may spread to contiguous paranasal sinuses, palate, orbit, or brain, and is associated with high mortality. The disease is often seen in association with pulmonary infection.
In patients with extensive or progressive pulmonary infection, life-threatening hypoxaemia may occur.
Chest CT scan or CXR would reveal multiple, bilateral, nodular, or diffuse infiltrates. Associated with a poor prognosis.
With tracheobronchitis, extensive pseudomembrane or ulcerative lesions may occur at the anastomotic site in lung transplantation.[1] Large lesions may produce obstruction resulting in unilateral wheeze or stridor.
X-rays may appear normal; high index of suspicion and bronchoscopy with biopsy are required for prompt diagnosis.
Prolonged course of systemic antifungals is required.
Aspergillus pericarditis may be a part of the disseminated process or result from local extension of pulmonary infection, leading to cardiac tamponade.
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